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Smoking During Pregnancy

Smoking during pregnancy statistics. In the United States today, approximately 10% of women smoke during pregnancy (March of Dimes. 2010. Smoking During Pregnancy Of women who smoked during the last 3 months of pregnancy, 52% reported smoking 5 or less cigarettes per day, 27% reported smoking 6 to 10 cigarettes per day, and 21% reported smoking 11 or more cigarettes per day.

Effects of smoking during pregnancy

Smoking during pregnancy can lead to a plethora of health risks to both the mother and the fetus. Smoking can cause
Early rupture of membranes

Early rupture of membranes means that the amniotic sac will rupture prematurely, and so will induce labor before the baby is fully developed. Oftentimes this will not be lethal to the fetus or the mother, but it would cause severe economic stress as the premature child would have to stay in the hospital to gain health and strength to be able to sustain life on it’s own.

Placenta previa

Placenta previa is when the placenta implants over the opening of the cervix. Having a placenta previa is especially dangerous as the baby would not be able to be born vaginally. If it were to be, the placenta would rupture before the baby was birthed, thus causing the mother to hemorrhage. Having a placenta previa, again, is an economic stress because it insists upon having a caesarean section delivery, which is more expensive and requires a longer recovery period in the hospital.

Ectopic pregnancy

An ectopic pregnancy is when the fetus implants itself outside of the uterus. This could prove fatal to the mother, and will be fatal to the fetus. The most common place for the fetus to implant is within the Fallopian Tubes, which could burst upon the fetus becoming too large if it is not caught before that time comes.

Placental Abruption

Finally, placental abruption is the premature separation of the placenta from the attachment site. This again can cause problems to both the mother and the fetus. The mother could lose large amounts of blood and hemorrhage. The fetus could be put in distress because they cannot receive the proper amount of nutrients or oxygen, and so the placental abruption could cause the fetus’ death. Babies born to women who smoke during pregnancy also have roughly 30% higher odds of being born prematurely.

Implications for the umbilical cord

Smoking can also impair the general development of the placenta. Impairing placental development is problematic because it reduces blood flow to the fetus. If the placenta is not developing fully, the umbilical cord (which transfers oxygen and nutrients from the mother's blood to the placenta) cannot do its job fully. If the umbilical cord cannot transfer enough oxygen and nutrients to the fetus, it will not be able to fully grow and develop. These conditions can result in heavy bleeding during delivery that can endanger mother and baby, although cesarean delivery can prevent most deaths.

SIDS

Another perspective on the effects of smoking during pregnancy is the research done on Sudden Infant Death Syndrome (SIDS), low birthweight babies, early delivery, and fetal growth restriction. SIDS is the sudden death of an infant that is unexplainable by the infant’s history. The death also remains unexplainable upon autopsy. Infants exposed to smoke, both during pregnancy and after birth, are found to be more at risk of SIDS due to the increased levels of nicotine often found in SIDS cases.

Low birthweight

Smoking nearly doubles the risk of low birthweight babies. In 2004, 11.9% of babies born to smokers were low birthweight as compared to only 7.2% of babies born to nonsmokers. More specifically, infants born to smokers weigh on average 200 grams less than infants born to women who do not smoke. Premature and low birthweight babies face an increased risk of serious health problems as newborns in addition to chronic lifelong disabilities such as cerebral palsy (a set of motor conditions causing physical disabilities), mental retardation and learning problems. Overall, they also face an increased risk of death. Additionally, the risk of Sudden Infant Death Syndrome increases 1.4 to 3.0 times in babies born to smoking mothers as compared to those born to non-smoking mothers.

Other birth defects

Smoking can also cause other birth defects, reduced birth circumference, altered brainstem development, and altered lung structure. Recently the U.S. Public Health Service reported that if all pregnant women in the United States stopped smoking, there would be an estimated 11% reduction in stillbirths and a 5% reduction in newborn deaths.

Quitting during pregnancy

Quitting smoking at any point during pregnancy is more beneficial than continuing to smoke throughout the entire 9 months of pregnancy, especially if it is done within the first trimester (within the first 12 weeks of pregnancy). A recent study suggests, however, that women who smoke anytime during the first trimester put their fetus at a higher risk for birth defects, particularly congenital heart defects (structural defects in the heart of an infant that can hinder blood flow) than women who have never smoked. That risk only continues to increase the longer into pregnancy a woman smokes, as well as the larger number of cigarettes she is smoking. This continued increase in risk throughout pregnancy means that it can still be beneficial for a pregnant woman to quit smoking for the remainder of her gestation period.

There are many resources to help pregnant women quit smoking such as counseling and drug therapies. For non-pregnant smokers, an often-recommended aid to quitting smoking is through the use of Nicotine replacement therapy in the form of patches, gum, inhalers, lozenges, sprays or sublingual tablets (tablets which you place under the tongue).

However, it is important to note that the use of Nicotine Replacement Therapies (NRTs) is questionable for pregnant women as these treatments still deliver nicotine to the child. For some pregnant smokers, NRT might still be the most beneficial and helpful solution to quit smoking. It is therefore important to talk to your doctor to determine the best course of action on an individual basis.

Smoking After Pregnancy

Children who are exposed to secondhand smoke after birth are more likely to die of SIDS than children in a smoke-free environment. Babies born to women who smoked during pregnancy are up to 3 times more likely to die of this condition that children born to non-smoking mothers.

Infants born to smoking mothers are also at increased risk for bronchitis, pneumonia, ear infections, severe asthma, impaired respiratory function and slowed lung growth. Bronchitis results when the mucous membranes of the bronchi are inflamed. This interferes with the movement of breath and airflow throughout the respiratory system. Similarly, pneumonia (which can come about due to bronchitis) arises from the inflammation of the lungs. It also causes the alveoli in the lung to fill with fluid. Asthma is an inflammatory disease that affects the respiratory airways and causes breathing difficulties. It is currently the number one reason for children chronically missing school. Asthma can also hinder a child's ability to get the necessary amount of daily physical activity. So not only can asthma affect a child's performance in school due to having to miss lessons, it can also cause some level of obesity and lethargy in children.

In addition, a 2003 study showed that babies born to mothers who smoked during pregnancy often undergo withdrawal-like symptoms similar to babies born to mothers who used illicit drugs during pregnancy. These babies tend to be more jittery and are harder to soothe than babies born to non-smokers. Premature birth (a concern with smoking during pregnancy) can create respiratory problems in newborn babies. One of the main reasons for these respiratory issues stems from inadequate production of surfactant in the lungs of the newborn. Surfactant reduces water tension in the lungs which is necessary to ensure that the alveoli in the lungs remain open and do not run the risk of “sticking” together. Without surfactant, water molecules that are a part of the air an infant would inhale would “stick” to each other and ultimately cause the lungs to collapse. This would mean that the newborn would be unable to breathe and therefore would not receive any oxygen.

A recent study has proposed that maternal smoking during pregnancy can lead to future teenage obesity. While no significant differences could be found between young teenagers with smoking mothers as compared to young teenagers with nonsmoking mothers, older teenagers with smoking mothers were found to have on average 26 percent more body fat and 33 percent more abdominal fat than similar aged teenagers with non-smoking mothers. This increase in body fat may result from the effect smoking during pregnancy, which is thought to impact fetal genetic programming in relation to obesity. While the exact mechanism for this difference is currently unknown, studies conducted on animals have indicated that nicotine may affect brain functions that deal with eating impulses and energy metabolism. These differences appear to have a significant affect on the maintenance of a healthy, normal weight. As a result of this alteration to brain functions, teenage obesity can in turn lead to a variety of health problems including diabetes (a condition in which the affected individual’s blood glucose level is too high and the body is unable to regulate it), hypertension (high blood pressure), and cardiovascular disease (any affliction related to the heart but most commonly the thickening of arteries due to excess fat build-up) . Additionally, recent studies also show that smoking during pregnancy increases the likelihood offspring beginning to smoke at an early age.

If one does continue to smoke after giving birth, however, it is still more beneficial to breastfeed than to completely avoid this practice altogether. There is evidence that breastfeeding offers protection against many infectious diseases, especially diarrhea. Even in babies exposed to the harmful effects of nicotine through breast milk, the likelihood of acute respiratory illness is significantly diminished when compared to infants whose mothers smoked but were formula fed. Regardless, the benefits of breastfeeding outweigh the risks of nicotine exposure. The main concern about smoking and breastfeeding is that infants may have smoking-induced reductions to the milk iodine content.

Smoking can adversely affect the lactation process by decreasing milk production and altering the milk composition. Smoking reduces daily milk output by roughly 250-300 mL. Not only will this be problematic on a daily basis for not producing enough milk, it will also cause the mother to wean her baby early. The altered milk composition also caused infants to exhibit daily behaviors such as colic and crying which can promote early weaning, again something that is not beneficial to the infant.

Ideally, women should not smoke before, during or after pregnancy. If this is not possible, however, the daily number of cigarettes must be reduced to a minimum to minimize the risks for both the mother and child. This is particularly important for women in undeveloped countries where breastfeeding is essential for the child’s overall nutritional status.

Secondhand Smoke

Non-smokers, but pregnant non-smokers in particular need to take care to avoid exposure to secondhand smoke altogether. This phenomenon is also known as passive smoking or environmental tobacco smoke (ETS) because bystanders are exposed to the detrimental effects of inhaled tobacco smoke. In “innocent bystanders,” secondhand smoke can contribute to disease, disability and death, results similar to that of smoking itself. Considerable evidence has proven that exposure to secondhand smoke increases the likelihood of developing cardiovascular diseases, lung cancer, breast cancer, renal cell carcinoma (RCC), brain tumors and respiratory diseases. Exposure to environmental tobacco smoke also contributes to the risk of ear infections, reduced heart rate variability and higher heart rate.

Additionally, it can increase the risk of atherosclerosis (a hardening of the arteries as a result of the build-up of cholesterol), increase the risk of asthma and lead to cognitive impairments and dementia. As a result of these harmful effects, all of which are similar to that of smoking, smoking bans have been implemented in institutions such as hospitals, restaurants and bars worldwide; this action is a powerful testament to the scientific consensus that secondhand smoke is a serious health risk to the general population.

Overall, exposure to secondhand smoke is estimated to be the 3rd leading cause of preventable death in the United States. It is calculated to kill a total of 53,000 non-smoking adults and children per year.

However, the environmental hazard of secondhand smoke can prove particularly harmful to pregnant women and their unborn offspring. Pregnant women who live in homes where others smoke, even if they do not smoke themselves, are constantly exposed to secondhand smoke; their offspring are at an equally detrimental risk for health problems mentioned previously as infants borne to smoking mothers. Exposure of secondhand smoke to pregnant women can lead to low birth weight and the US Surgeon General’s 2006 report listed premature birth as a suggestive result of exposure to secondhand smoke as well.

Take Action

It has been scientifically proven that smoking cessation can significantly contribute to better health outcomes for adults, children and infants alike. While some health effects of smoking are irreversible, some health benefits may result after smoking cessation; cardiovascular efficiency increases after smoking cessation in addition to a restoration of normal blood pressure levels, oxygen levels, carbon monoxide levels in the lungs, mucus in the lungs begins to clear, nicotine leaves the body and taste buds improve. Specifically related to pregnancy, however, is the restoration of normal fertility in both women and men. Similarly, likelihood of miscarriage is greatly reduced when exposure to tobacco smoke—both directly as well as indirectly (via secondhand smoke) is reduced.

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